Insurers' online forums invite patients to vent

"Not happy" wrote to complain about the 90-minute wait to be seen at a dermatologist's office. "Disgusted" said that a certain doctor "refuses to communicate with patients." But "CarolaBen" responded to "Disgusted" that this doctor returned every call placed by her regarding her husband's liver duct problem.

These comments were posted on The Healthcare Scoop, a place where patients can talk openly about experiences with physicians and hospitals. Patients name names, whether the experience was good or bad. But for the most part, the patients remain hidden behind pseudonyms.

Patients posting on the Internet with fake names about real doctors is hardly a new phenomenon. But what is particularly upsetting to physicians about The Healthcare Scoop is the company behind it -- Blue Cross Blue Shield of Minnesota.

Physicians already have battled insurers over the quality of data used in creating physician ratings and tiered health plans. Now organized medicine is feeling uncomfortable about insurers moving into the realm of gathering and disseminating unfettered patient feedback.

"While we encourage open patient communication with their physicians, we are concerned that the public reporting of results from anonymous, Web-based patient satisfaction surveys may be counterproductive," said Edward L. Langston, MD, chair of the AMA Board of Trustees and a family physician in Lafayette, Ind.

"It is extremely difficult for such surveys to distinguish whether patient dissatisfaction, resulting from denied or delayed services, or failure to obtain a certain prescription, is due to the decision of the physician or the demands and restrictions of the health insurer," he said.

What's the scoop?

The few plans that have gotten into this business -- mainly, the Minnesota Blues and WellPoint -- say the consumer ratings won't affect physician reimbursement. But they say they hope it makes the medical system more transparent to patients, who, surveys show, rely often on word-of-mouth when choosing a doctor.

The Health Care Scoop (link) premiered in November 2007. Blue Cross Blue Shield of Minnesota is not auditing, filtering or moderating the site, except for profanity or when a user alerts them to inappropriate content, said Marianne Stump, chief innovation officer for the Eagan, Minn.-based plan. "We're the host only," Stump said. "The community governs itself the same way it would in any online community."

The site isn't limited to Minnesota Blues members. Anyone, anywhere with an e-mail address can post what the site calls a "health care story."

The 170 "stories" posted so far are a mix of positive and negative about physicians, nurses and experiences during procedures. One explains why "non-Christians" shouldn't go to a practice that "clearly ... is a faith-based clinic." Another praised an urgent-care clinic for "saving my life." As of Jan. 15, 84 physicians and 75 clinics and hospitals had been named in comments. Positive comments outnumbered negatives at a 4-1 ratio.

Stump said these comments are the sorts of things people are saying to each other, and its member focus groups repeatedly expressed a desire for the Blues to have an online forum as well as quantitative rating data, which is available on another site, healthcarefacts.com.

The difference is that online comments last and linger much longer, said James Dehen, MD, a general surgeon from Brainerd, Minn., who serves as president of the Minnesota Medical Assn. He said the organization hadn't yet discussed the new site. But Dr. Dehen said he was concerned about the potential harm it would do to doctors' practices.

"Once things get out on the Web, there's no bringing them back," he said. "People always are going to use word of mouth, but Mrs. Jones getting mad about something and complaining at a tea party and then reconsidering, that is not the same as putting that on a World Wide Web site."

Meanwhile, in other states, physicians are beginning to complain about the premiere of WellPoint's use of the Zagat ratings system -- more famously used for restaurants -- as a way to rank doctors.

On Jan. 8, WellPoint launched the system in metropolitan Los Angeles, the Cincinnati and Dayton metro areas in Ohio, and statewide in Connecticut. Patients assign doctors an overall score, a figure broken down by four categories: trust, communication, availability and environment. The Zagat site does not post a composite score for a physician until at least 10 members have scored them, but member comments appear right away, she said.

WellPoint has promised to audit the comments to make sure members posting about a physician have indeed seen that physician.

Connecticut State Medical Society Executive Director Matthew Katz said many members had been in touch with his association to express concern about the site, and the group in turn had shared those comments with WellPoint. "This does not seem to in any way improve the patient-physician relationship and may in fact create a barrier," he said.

One major complaint the society had is the lack of access physicians have to comments about them. WellPoint spokeswoman Jill Becher said the plan intends to allow doctors and other caregivers to see those, but access through "existing provider portals" wouldn't be open until late 2008. In the meantime, WellPoint will mail doctors copies of comments about them later this year, she said. Becher said early comments on WellPoint's Zagat site were mostly positive.